Infection/Inflammation
Institutional Characteristics Associated with Receipt of Emergency Care for Obstructive Pyelonephritis at Community Hospitals Michael S. Borofsky, Dawn Walter, Huilin Li, Ojas Shah,* David S. Goldfarb,† R. Ernest Sosa and Danil V. Makarov‡,§ From the Department of Urology (MSB, OS, RES, DVM), Nephrology Division (DSG) and Divisions of Comparative Effectiveness and Decision Science (DW, DVM) and Biostatistics (HL), Department of Population Health, New York University Langone Medical Center and Section of Urology (OS, RES, DVM) and Nephrology Section (DSG), New York Harbor Veterans Affairs Healthcare System, New York, New York
Purpose: Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients. Materials and Methods: We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care. Results: Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94e3.96, p
Institutional Characteristics Associated with Receipt of Emergency Care for Obstructive Pyelonephritis at Community Hospitals Michael S. Borofsky, Dawn Walter, Huilin Li, Ojas Shah,* David S. Goldfarb,† R. Ernest Sosa and Danil V. Makarov‡,§ From the Department of Urology (MSB, OS, RES, DVM), Nephrology Division (DSG) and Divisions of Comparative Effectiveness and Decision Science (DW, DVM) and Biostatistics (HL), Department of Population Health, New York University Langone Medical Center and Section of Urology (OS, RES, DVM) and Nephrology Section (DSG), New York Harbor Veterans Affairs Healthcare System, New York, New York
Purpose: Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients. Materials and Methods: We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care. Results: Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94e3.96, p
